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REC Roadblocks

April 12, 2010
by David Raths
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Identifying gaps in functionality and selling physicians on the benefits of EHRs remain the top challenges for REC leaders.

The leaders of organizations that have won grant funding to become regional extension centers (RECs) are optimistic about their roles in fostering physician IT adoption and encouraged by the initial positive response from the provider community.

But they also realize they have plenty of issues to address. During an April 7 webinar hosted by the eHealth Initiative, several REC leaders talked about what they see as their top challenges.

The webinar began with remarks from Mat Kendall, acting director of the Office of Provider Adoption Support, the section of the Office of the National Coordinator responsible for RECs. He noted that for the first two years of the program, 60 RECs would receive $644 million and geographically cover about 98 percent of the U.S. population.

Kendall’s office is working with other ONC staff to provide support for services such as vendor selection and group purchasing, practice and workflow redesign, and functional interoperability. The approach, he said, is not one of issuing top-down directives, but rather a collaborative effort to identify and share best practices from around the country. To that end, several online “communities of practice” are already up and running.

Several REC leaders said they are looking at a practice population in which 30 percent reported having some sort of EHR and 70 percent have no experience with EHRs.

Fred Rachman, M.D., co-director of the Chicago Health Information Technology Regional Extension Center, noted that many of the physicians who report having EHRs actually use only a small fraction of their functionality, so one initial challenge will be to “map” the practices to get a status report on what they need to get to meaningful use. “We have to understand their existing support infrastructure and where there are gaps in functionality and then provide services to fill those cracks,” he said. For instance, he noted, e-prescribing adoption is relatively low in Chicago, so that will be an area of focus. Offering true value-added services, instead of replicating or duplicating existing services, will allow the RECs to become sustainable, he said.

Jonathan Fuchs, chief operating officer of the Arkansas Foundation for Medical Care and project director for HIT Arkansas, said he was concerned about the availability of appropriate staffing. Fuchs said that despite the funding for new programs at the community college and university levels to pump up the pipeline of workers, there are more immediate staffing needs to be met so that the 60 RECs and the EHR vendors can hit the ground running.

Facing short timelines and limited funding of about $5,000 per physician, one challenge is “closing the sale” with thousands of physicians who have expressed interest in their services. Sharon Donnelly, vice president of development at HealthInsight, the REC covering Utah and Nevada, said she is concerned that some physicians will hold back from participating. She sees her job as demonstrating to them clear reasons EHRs can improve operations without disrupting their practices.

“It is a challenge to get physicians to participate in services that they have underappreciated until now,” said Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative. He noted that an earlier successful effort, the NYC Primary Care Information Project, required on average 22 separate contacts to close a sale and that was a situation in which the organization was giving the software away.

Another concern Tripathi mentioned is that RECs, facing pressure to hit their stated goals, could be tempted to work first with the 30 percent of physicians who have already taken the initial steps toward meaningful use rather than the more difficult task of engaging those who are starting from scratch.